This retrospective study aimed to compare the efficacy and safety of conventional lipiodol-based transarterial chemoembolization (TACE) combined with prophylactic right inferior phrenic artery (RIPA) embolization versus TACE alone for hepatocellular carcinoma (HCC) located in liver segments VII and VIII. After propensity score matching of 161 eligible patients, 52 received TACE alone (Group A) and 52 received TACE plus prophylactic RIPA embolization (Group B). Primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), time to progression (TTP), tumor response, and adverse events (AEs). The combination therapy significantly improved survival outcomes. Median OS was 32.3 vs. 28.3 months, median PFS was 18.8 vs. 16.5 months, and median TTP was 19.3 vs. 17.5 months. Multivariable Cox analysis confirmed prophylactic RIPA embolization as an independent favorable prognostic factor for OS (HR 0.511, P=0.008), PFS (HR 0.528, P=0.003), and TTP (HR 0.502, P=0.002). Other independent factors included tumor number >3 and Child-Pugh class. The 1-month objective response rate showed no significant difference (67.3% vs. 55.8%, P=0.277). Regarding safety, the overall AE rate was similar between groups (44.2% vs. 42.3%). Complications specifically associated with RIPA embolization in Group B included shoulder pain (19.2%) and hiccups (13.5%), which were mild and self-limited. The incidence of major complications (SIR class C-F) was not significantly different (7.7% vs. 3.8%, P=0.678). One patient in Group B developed a grade 4 liver abscess. For HCC in segments VII/VIII, adding prophylactic RIPA embolization to conventional lipiodol-based TACE provides significant survival benefits, establishing it as an independent prognostic factor, without substantially increasing major treatment-related morbidity. This combined approach represents a valuable therapeutic strategy for this specific patient subset.

Upper limb injuries are common and account for a significant number of emergency department and primary care consultations. While surgery for these injuries is well-documented, nonoperative treatments, particularly the optimal duration of immobilization, remain understudied. These durations are often based on institutional dogma rather than scientific evidence, which have gone unchallenged for years. However, prolonged immobilization can lead to increased morbidity or even complications for patients. The aim of this systematic literature review is to update the recommendations regarding optimal immobilization durations for the most common shoulder and elbow injuries, in order to provide guidelines for primary care and emergency medicine.

Objective: This study aimed to evaluate the effects of transcutaneous auricular vagus nerve stimulation (taVNS) combined with a home exercise program on pain, range of motion (ROM), kinesiophobia, depression, and quality of life in patients with frozen shoulder. Methods: Eighty-one patients diagnosed with frozen shoulder were randomized into three groups: home exercise therapy, taVNS, and combined exercise + taVNS therapy. Pain intensity was assessed using the visual analog scale (VAS), depression with the Beck Depression Inventory, quality of life with the SF-36 questionnaire, shoulder ROM with goniometric measurements, shoulder function with the Shoulder Pain and Disability Index (SPADI), kinesiophobia with the Tampa Scale, and upper extremity functional limitation with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Results: Significant improvements were observed in shoulder flexion and extension in the exercise group, while significant gains in abduction and adduction were detected in the combined exercise + taVNS group (p<0.05). SPADI and VAS scores showed statistically significant reductions in all groups following treatment (p<0.05). In addition, kinesiophobia and depression scores significantly decreased across all groups after the intervention period (p<0.05). Conclusion: Transcutaneous auricular vagus nerve stimulation appears to be a safe and effective adjunct to conventional exercise therapy in the management of frozen shoulder; however, its additional benefits beyond exercise alone may be limited.

Parsonage–Turner syndrome (PTS) is a form of brachial plexus neuropathy characterized by acute pain followed by weakness in the upper limb. Due to its rarity, reporting individual clinical observations remains relevant. This article presents a case of a 59-year-old woman who developed left shoulder pain and upper limb monoparesis almost simultaneously. An ischemic stroke was suspected at the pre-hospital stage but was ruled out by brain MRI. The diagnosis of PTS was made based on the clinical presentation and findings of stimulation electromyography. Corticosteroid therapy resulted in a marked reduction of pain and improvement in muscle strength.

Many with chronic shoulder pain due to subacromial impingement syndrome have persistent pain. Motor stimulation is an emerging treatment that may increase efficacy of physical therapy as part of a multimodal treatment. The aim of the study was to evaluate the efficacy of physical therapy and axillary motor stimulation among participants with chronic subacromial pain. This study used a dual-site, randomized, participant and assessor-blinded, placebo-controlled trial. One hundred sixteen participants with chronic shoulder pain due to subacromial impingement syndrome. Participants were randomized to receive physical therapy + motor stimulation (n = 60) or physical therapy + no stimulation (n = 56). The primary outcome was the worst pain in the past week (Brief Pain Inventory, Short Form, question 3). Secondary outcome measures included other questions of the Brief Pain Inventory, the Shoulder Pain and Disability Index, Functional Assessment Test-Hand/Neck/Shoulder/Arm, and Short-Form 36. Both groups experienced significant improvements over time in all assessed outcome measures. There was not a significant difference between the groups. No significant adverse events related to the interventions were observed. For those with chronic subacromial impingement syndrome, physical therapy + motor stimulation is efficacious in reducing shoulder pain and improving function, although physical therapy alone may be sufficient if patients can complete a standardized protocol.

Refractory pain of the shoulder hinders independence and decreases quality of life. Sixty-day peripheral nerve stimulation (PNS) treatment has shown the ability to provide substantial and sustained relief in patients with chronic shoulder pain. The present study aims to identify key patient and treatment characteristics that may be utilized by physicians to optimize patient outcomes. An institutional review board-approved retrospective chart review evaluated patients who previously underwent 60-day PNS treatment for their chronic shoulder pain. Patient and treatment characteristics were extracted from electronic medical records and analyzed alongside patient-reported outcomes provided at the end of treatment. Overall, 221 patients were included in the study. Of patients with available outcomes, 75% (n = 132/176) reported substantial (i.e., ≥50%) pain relief at end of treatment. PNS treatment effectiveness was consistent when stratified by several factors, including the chronicity of pain, patient age, and the cause of pain. Regression analyses identified characteristics associated with successful outcomes. The study highlights the effectiveness of 60-day peripheral nerve stimulation treatment across a variety of shoulder pain types and medical histories. These findings complement previous studies and real-world evidence supporting PNS in the management of chronic shoulder pain and provide insights that may inform patient selection and optimization of 60-day PNS treatment.

Long head of biceps tendinopathy (LHBT) is a common source of anterior shoulder pain, often misdiagnosed due to overlapping symptoms with other shoulder disorders. This case report presents a 56-year-old female with chronic shoulder pain managed through a clinical reasoning-guided physiotherapy program. Assessment using clinical reasoning, including the International Classification of Functioning, Disability, and Health (ICF) framework, confirmed LHBT. The intervention included pain management, manual therapy, range of motion exercises, strengthening exercises, and patient education over 6 weeks. Outcomes showed marked improvements: pain decreased from 7/10 to 1/10, muscle strength improved from 4/5 to 5/5, and functional disability scores (SPADI, DASH) reduced by over 80%. These findings demonstrate that structured, reasoning-based physiotherapy can facilitate accurate diagnosis and effective recovery in LHBT. This approach provides a model for evidence-informed, individualized clinical reasoning-based rehabilitation in similar musculoskeletal conditions.

"Fighter's shoulder" part I: impact on shoulder motion and scapular movement in judo and jiu-jitsu athletes.

Exploratory analysis of relationship between trunk and pelvic motion and shoulder motion during throwing in quarterbacks in American football.

Clinical and structural outcomes of arthroscopic rotator cuff repair augmented with biceps-based partial superior capsular reconstruction and distal tenotomy at two-year follow-up.

Initial safety outcomes of adipose-derived mesenchymal stem cell for rotator cuff tear: A 3-year pilot trial.

ABSTRACT Extrapulmonary tuberculosis is uncommon, and musculoskeletal involvement presenting as migratory arthritis is particularly rare in immunocompetent individuals, often leading to misdiagnosis and delayed treatment. We report the case of a 66‐year‐old man with diabetes mellitus who presented with recurrent migratory inflammatory arthritis affecting multiple joints over 1 year, without initial pulmonary symptoms. He was initially diagnosed with rheumatoid arthritis based on positive rheumatoid factor and elevated inflammatory markers and was treated with disease‐modifying antirheumatic drugs without clinical improvement. At presentation, he reported severe shoulder pain, morning stiffness, weight loss, and night sweats. Imaging revealed right upper lobe consolidation and a metabolically active cavitary lung lesion on PET‐CT. Bronchoalveolar lavage culture confirmed Mycobacterium tuberculosis . Antituberculous therapy was initiated, resulting in marked clinical improvement and resolution of arthritis within weeks. This case highlights tuberculosis as an important, underrecognized cause of migratory arthritis and emphasizes the need to consider infectious etiologies in treatment‐resistant inflammatory joint disease, particularly in endemic regions.

To evaluate ultrasound's diagnostic value for full-thickness supraspinatus tendon (SST) tears and correlate it with arthroscopy findings. In this retrospective study, patients with a clinical diagnosis of rotator cuff tears were included. The inclusion criteria were patients with shoulder joint pain and limited shoulder mobility. The exclusion criteria comprised patients who had undergone any previous shoulder surgery or those with shoulder fractures or dislocations. Ultrasound imaging features were observed and recorded, including measurements of the length and width of tears to reveal tear patterns. The chi-square test was used to compare the clinical characteristics of categorical variables, and the Wilcoxon test was used to assess the correlation between ultrasound and arthroscopy. From January 2023 to November 2023, 105 patients diagnosed with rotator cuff tears were included (50 males, 55 females, mean age 67.9 ± 14.2 years). Arthroscopy confirmed full-thickness SST tears in 82 patients (78.1%). Ultrasound demonstrated differential diagnostic performance across tear patterns: sensitivity/specificity 90.0%/95.8%(crescent), 93.1%/94.3% (U-shaped), 83.8%/98.0% (L-shaped), and 100%/98.6% (giant), with corresponding area under the ROC curves (AU-ROCs) of 0.789-0.882. Significant correlations were observed between ultrasound and arthroscopic measurements, particularly for crescent-type tear width (r = 0.949, p < 0.001). Ultrasound effectively distinguishes SST tear types, with high concordance to arthroscopy, supporting its use as a primary imaging tool for surgical planning in rotator cuff pathology. Ultrasound has significant application value in the diagnosis of full-thickness of SST tears. Ultrasound shows high consistency with arthroscopic findings and can effectively differentiate various tear patterns.

Background: Rotator cuff tendinopathy is a major cause of shoulder pain and disability. Focused extracorporeal shockwave therapy (ESWT) is an established conservative treatment option; however, the predictive factors influencing the treatment response remain poorly characterized. Objectives: To identify clinical, demographic, and metabolic predictors of pain reduction and functional improvement at four months following focused ESWT in patients with supraspinatus tendinopathy, with the goal of informing individualized treatment planning and early prognostic counseling. Methods: This retrospective cohort study analyzed patients with supraspinatus tendinopathy (calcific and non-calcific) treated with focused ESWT at a university rehabilitation center between June 2020 and December 2025. Outcomes were assessed at baseline and 4-month follow-up using the Visual Analog Scale (VAS), Roles and Maudsley, and Constant–Murley scores. Change score analysis with covariate adjustment and backward stepwise selection were performed to identify predictors of clinical improvement. Results: A total of 239 patients (97 males [40.6%], 142 females [59.4%]; mean age 60.2 ± 11.5 years; mean BMI 25.5 ± 4.0 kg/m2) were included, of whom 101 (42.3%) had calcific tendinopathy. Significant improvements were observed in all outcomes: VAS decreased from 6.50 ± 1.35 to 3.96 ± 2.09 (p &lt; 0.001; Cohen’s d = 1.24), and Constant–Murley score increased from 60.38 ± 14.53 to 75.88 ± 15.52 (p &lt; 0.001; Cohen’s d = 1.07). Patient-reported satisfaction (Roles and Maudsley score) showed a 91.2% success rate (excellent or good outcomes). Regression analysis identified baseline severity as the strongest predictor of improvement in all models. BMI emerged as a significant predictor of functional recovery (β = −0.95, p &lt; 0.001 for Constant–Murley change), with each 1 kg/m2 increase associated with approximately 1-point less improvement. Conclusions: Baseline clinical severity and body mass index were consistent predictors of ESWT effectiveness in rotator cuff tendinopathy. A lower BMI was associated with greater functional improvement, highlighting a potentially modifiable factor for treatment optimization. These findings support personalized treatment planning and early prognostic counseling in clinical practices.

ABSTRACT Background Streptococcus equi subspecies zooepidemicus (SESZ) is an uncommon zoonotic pathogen in humans but can cause severe joint infections. Reported cases are often linked to exposure to horses, dairy products, or raw pork, though infections may occur without an identifiable animal source. Case Summary An 84-year-old man with multiple comorbidities presented with acute left shoulder pain, fever, and chills. Synovial fluid aspiration yielded turbid fluid containing calcium pyrophosphate dihydrate crystals, while Gram stain was negative. Despite empiric broad-spectrum antibiotics, his symptoms persisted, requiring surgical irrigation and debridement. Cultures from the joint aspirate and drain revealed β-hemolytic, mucoid colonies of gram-positive cocci (Lancefield group C), identified as SESZ by Vitek 2, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and whole-genome sequencing. Interestingly, the isolate had an atypical biochemical phenotype, i.e., it could not ferment sorbitol. Antimicrobial therapy was changed to intravenous ceftriaxone according to susceptibility testing, resulting in subsequent clinical improvement. Conclusion Although rare, SESZ should be considered in the differential diagnosis of septic arthritis, particularly in elderly patients, even in the absence of clear zoonotic exposure. Timely recognition, adequate surgical drainage, and prolonged targeted antimicrobial therapy are essential for favorable outcomes.

Acromioclavicular Joint (ACJ) dislocation is a major form of shoulder injury, accounting for about 9% of shoulder injuries. It is commonly seen in athletes involved in direct oppositional, contact sports (e.g., field hockey, rugby, and soccer.) The ACJ plays a critical role in normal upper extremity motion function, but intense opposition, as well as its structural complexity, make it susceptible to acute injury and dysfunction. Therefore, it is of great interest to explore the anatomical basis of ACJ dislocations, analyze the mechanisms by which such ACJ dislocations occur, and discuss in detail how imaging techniques can be used to assess the extent of injury. In this review, we explore the aforementioned processes and mechanisms, as well as the treatment options for ACJ dislocation, with a focus on how to differentiate between surgical and nonsurgical treatment methods. The considerations for ACJ treatment are also further elaborated by comparing the effectiveness and potential complications of the various treatment methods. Finally, the paper summarizes the rehabilitation process for patients with ACJ dislocation, including necessary short-term physical therapy and long-term treatment strategies. Despite the fact that acromioclavicular joint dislocations are currently well researched as well as very well studied, and a variety of treatments have been proposed and practiced, the challenge remains to maximize functional recovery and minimize the risk of recurrence. By exploring the anatomical basis of ACJ dislocations, summarizing the mechanisms, evaluating the imaging, summarizing the treatment protocols, and rehabilitating the process, we will be able to provide an optimal treatment plan for this type of patient in the future, which will significantly improve the patient's quality of life.

Introduction with Objective: Shoulder pain is a common musculoskeletal presentation in the general practice which can lead to absenteeism from work, inability to perform social activities and serious economic hardship for affected individuals and their families. The aim of this study was to assess the socio-demographic and clinical outcome of the patients with shoulder pain in a tertiary care hospital in Bangladesh. Methods: This Prospective observational Study was carried out among 101 patients attending at the Department of Physical Medicine and Rehabilitation, Dhaka Medical College and Hospital (DMCH), Dhaka within the defined period from July 2021 to December 2021. Ethical clearance was obtained from the Ethical review committee of Dhaka Medical College Hospital. Purposive sampling was done according to availability of the patients. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-20.1). Results: Majority of the patients (59.4%) were in 41-50 years age group where the mean age of the patients was 50.3 ± 7.9 years and 51 (50.5%) patients were male. Majority of the patients (45.5%) were housewives. Most of the patients (n=94, 93.1%) had normal body mass index. Majority of the patients (56.4%) had duration of pain for 1-3 months where the mean duration of pain of the patients was 3.9 ± 2.5 months. The mean pain score in VAS was 4.9 ± 1.1 where 47 patients (46.5%) had score from 3-4. Local tenderness was present in rotator cuff muscle in 88 (87.1%) patients while 65 (64.4%) had tenderness on Gleno-humeral joint. Majority of the patients (59.4%) had shoulder pain on right shoulder. Conclusion: Shoulder pain is more common in older people, with the peak prevalence occurring in people aged 41-50 years and more common in male. Obesity is a risk factor for shoulder pain. Recognizing high-risk patients can help physicians for counseling them and recommend strategies for prevention. Medicine Today 2026, Vol.38 (1): 93-95

Combined central and peripheral demyelination (CCPD) is a rare chronic demyelinating disorder. Neurofilament (NF) proteins are structural components specific to neuronal intermediate filaments within axons. The presence of anti-neurofilament antibodies is typically associated with axonal pathology and is seldom observed in patients with CCPD. We present a case of CCPD in a patient who tested positive for immunoglobulin G (IgG) antibodies against the neurofilament heavy chain (NF-H-IgG) in both cerebrospinal fluid (CSF) and serum. Since 2019, the patient has exhibited a constellation of neurological symptoms, including severe neck and shoulder pain, left-sided limb weakness, distal extremity numbness, left-eye visual blurring, and impaired deep sensation. Electrophysiological and clinical evaluations indicated a primarily demyelinating peripheral neuropathy with secondary axonal involvement. Following treatment with low-dose corticosteroids in combination with cyclophosphamide (CTX), the patient demonstrated marked clinical improvement.

Background: Occupational hazards in dentistry biological, chemical, physical, ergonomic and psychosocial pose significant risks during undergraduate training. We assessed knowledge, attitudes and practices (KAP) regarding occupational hazards among undergraduate dental students to identify gaps that can be addressed through education and policy. Methods: A cross-sectional survey was carried out at the Institute of Dental Studies and Technologies between 15 December 2025 and 30 January 2026. A structured, self-administered questionnaire (six sections: demographics; knowledge; attitude; practice; domain-specific awareness; training/need assessment) was completed by 453 students. Descriptive statistics (frequencies, percentages) summarized KAP; only fully completed questionnaires were included. Results: Of 453 respondents, 311 (68.6%) were female; 150 (33.1%) reported prior formal training on occupational hazards. Knowledge was moderate: most students recognised that dentistry involves biological/chemical/physical hazards (78.4%) and the cumulative risks of X-rays (84.5%); however, awareness was lower for chemical hazards (formaldehyde 59.0%; mercury 65.8%), with notable “don’t know” responses. Attitudes were strongly positive 87.9% agreed occupational hazards are a serious concern and 85.7% endorsed PPE use yet 81.9% considered undergraduate training insufficient. Self-reported safety practices were generally high for infection control (87.0% “always/often”) and biomedical-waste disposal (89.2%), but only 53% always used protective eyewear during curing. High prevalences of work-related ill-health were reported: musculoskeletal disorders 52.1% (shoulder pain most common), psychological stress/burnout 70.2%, and glove-related irritation/latex allergy 64.7%. Importantly, 88.5% expressed willingness to attend structured occupational-safety workshops. Conclusion: Undergraduate dental students showed positive attitudes and generally good safety practices, but notable gaps in formal training and knowledge especially regarding chemical hazards and ergonomics remain. High levels of musculoskeletal problems and stress highlight the need to integrate structured occupational-safety education, practical training, and wellness support into the curriculum.

Limited available evidence seems to suggest that the increased use of the dominant (versus nondominant) limb may allow for earlier return to function and better ROM in the dominant limb at 12-month follow-up after anatomic or reverse total shoulder arthroplasty (TSA). Nevertheless, whether the earlier achievement of physical therapy milestones is associated with a clinically meaningful difference in patient-reported outcome measures (PROMs) is yet to be determined. (1) What are the 12-month minimum clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for the Shoulder Pain and Disability Index (SPADI), QuickDASH, numeric rating scale (NRS) for pain, and Constant-Murley score? (2) Is there a difference between the dominant- and nondominant-side TSAs in terms of the proportions of patients achieving an MCID or PASS at 12-month follow-up? This retrospective, comparative study analyzed data from a longitudinally maintained shoulder arthroplasty registry at a specialized orthopaedic institution. Patients were eligible for inclusion if they underwent primary anatomic or reverse TSA from 2006 to 2024 for cuff tear arthropathy or primary osteoarthritis and had 12-month follow-up for at least one PROM. We collected relevant baseline patient-related and procedure-related characteristics. The main association of interest was operated limb relative to limb dominance, and shoulders were stratified into the dominant-side or nondominant-side group. A total of 2152 shoulders, 65% (1404) of which were in the dominant-side group, were analyzed. The mean age was 73 years, and the majority of patients were women in both groups. In the dominant group, more patients were treated for cuff tear arthropathy, and a larger proportion received a reverse TSA. Loss to follow-up at 12 months did not differ between groups, reaching 13% for the dominant group and 16% for the nondominant group. The PROMs collected were the SPADI, QuickDASH, NRS for pain, and Constant-Murley score. These were administered at baseline and at 12 months postoperatively. The MCID and PASS thresholds for the PROMs of interest were estimated using a distribution-based approach. A sensitivity analysis was performed using the best available evidence for anchor-based MCIDs (20 for the SPADI, 12 for the QuickDASH, 2.2 for the NRS for pain, and 9 for the Constant-Murley score). Adjusted comparisons of distribution-based MCID estimates and PASS proportions between dominant- and nondominant-side procedures were conducted using generalized linear mixed-effects logistic regression models. Models were adjusted for admission type, surgical indication, procedure type, cuff tear severity, BMI, baseline ROM (forward flexion, abduction, external rotation), and baseline QuickDASH, with a random intercept for patient ID to account for within-patient clustering. Results are reported as ORs with 95% confidence intervals (CIs). Distribution-based absolute MCID estimates were 16 for SPADI, 13 for QuickDASH, 1.5 (reduction) for NRS for pain, and 12 for Constant-Murley score. Distribution-based absolute PASS estimates were 19 for SPADI, 5 for QuickDASH, 1.8 (reduction) for NRS for pain, and 20 for Constant-Murley score. At 12 months, MCID and PASS responder proportions did not differ in clinically important ways between dominant and nondominant shoulders, but approximately 25% (509 of 2120) of shoulders did not achieve the MCID for the QuickDASH, more than 10% (247 of 2123) did not achieve it for pain, and approximately 15% did not achieve a PASS for one or more outcomes tool. All absolute risk differences and 95% CIs fell within the prespecified ± 10% smallest important difference margin, indicating no clinically important dominance effect. In adjusted mixed-effects logistic regression models, dominance was not associated with meaningful differences in the odds of achieving MCID or PASS for SPADI, QuickDASH, NRS for pain, or Constant-Murley score (ORs near 1.0, with all CIs crossing unity). Across all sensitivity analyses, arm dominance demonstrated no association with 12-month MCID or PASS after TSA. Arm dominance was not meaningfully associated with an increased or decreased likelihood of achieving MCID or PASS across multiple PROMs. However, as many as 1 in 4 patients did not reach MCID or PASS thresholds after TSA, irrespective of arm dominance. These findings indicate that, in typical clinical practice, dominance should not be considered a major determinant of postoperative recovery expectations. Level III, therapeutic study.